Articulating endoscopic surgical apparatus

ABSTRACT

A surgical instrument is provided for use in endoscopic or laparoscopic procedures. The instrument includes a handle portion, an endoscopic portion extending from the handle portion, an articulating section pivotably connected to a distal end of the endoscopic portion, and a bladed retractor assembly operatively associated with the articulating section. Structure is provided for maintaining spacing between the blades of the retractor assembly and for controlling actuation of the retractor assembly.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.07/949,071 filed Sep. 22, 1992, pending which is a continuation-in-partof U.S. application Ser. No. 07/925,496 filed on Sep. 4, 1992, pendingwhich is a continuation-in-part of U.S. application Ser. No. 07/834,687filed on Feb. 12, 1992, pending and a continuation-in-part of U.S.application Ser. No. 07/874,743 filed on Apr. 27, 1992, pending which isa continuation-in-part of U.S. application Ser. No. 07/740,443 filed onAug. 5, 1991, now U.S. Pat. No. 5,199,419.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The subject invention relates to surgical apparatus for laparoscopic andendoscopic surgical procedures, and more particularly to apparatushaving an end portion which can be articulated in a patient's bodyduring a surgical procedure.

2. Description of Related

In laparoscopic and endoscopic surgical procedures a small incisionpuncture is made in the patient's body to provide access for a tube orcannulla device. Once extended into the patient's body, the cannulaallows insertion of various surgical instruments such as scissors,dissectors or retractors to perform the surgery.

An example of an endoscopic surgical instrument is illustrated in U.S.Pat. No. 2,113,246 which issued to Wappler on Apr. 5, 1938. This patentdiscloses endoscopic forceps comprising an elongated conduit with jawsat the distal end thereof, a control rod in the conduit for controllingthe operation of the jaws, and a control handle at the proximal end ofthe conduit which is operatively connected to the control rod. Thissurgical instrument is extremely limited in its applications in that theangle of the conduit portion mounting the jaws cannot be adjusted inrelation to the remaining portion of the conduit during a surgicalprocedure.

Improvements have been made in the art of surgical instruments toincrease their range of operability. For example, U.S. Pat. No.4,763,669 which issued to Jaeger on Aug. 16, 1988 discloses amicrosurgery instrument with an adjustable angle of operation forobtaining cervical biopsies.

Similarly, U.S. Pat. No. 4,880,015 which issued to Nierman on Nov. 14,1989 discloses a surgical device having an increased range ofoperability. In particular, this patent shows a biopsy forceps designedfor use through a flexible fiberoptic bronchoscope. The biopsy forcepsincludes a handle connected to a thin elongated flexible shaft with adistal portion thereof hinged to the shaft. A grasping tool or biopsyforceps attached to the distal hinged portion. Control wires extendedfrom the handle to the distal end to the shaft for controlling theangular rotation of the distal portion of the instrument.

Of the references discussed above, none of these instruments disclose alaparoscopic instrument for insertion into the body cavity through acannula and adapted for a wide range of laparoscopic surgicalapplications. Further, the instruments disclosed therein are not providewith means for rotating the tool head about the longitudinal axis of theendoscopic portion of the instrument. Instead, a surgeon using either ofthese prior art instruments must physically rotate the entire instrumentin order to change the rotational orientation of the distal end of theconduit or tube.

Accordingly, it is an object of the subject invention to provide anendoscopic surgical instrument having a tool head which is independentlymoveable about two axes of rotation relative to the handle while theinstrument is in use.

It is another object of the subject invention to provide a lightweightendoscopic surgical instrument which can provide a clearer line of sightfor a surgeon during a surgical procedure.

It is still another object of the subject invention to provide anendoscopic surgical instrument in which a wide variety of different toolheads may be employed.

It is yet another object of the subject invention to provide anendoscopic surgical instrument which may be used to performelectrocauterization during surgical procedures.

A further object of the subject invention is to provide an endoscopicsurgical instrument which may be used for performing retraction,grasping or dissecting tasks during gynecological procedures.

Another object of the subject invention is to provide an endoscopicsurgical instrument for performing retraction, grasping or dissectingtasks during abdominal surgery.

Another object of the subject invention is to provide an endoscopicsurgical instrument which is inexpensive to manufacture.

These and other objects of the subject invention will be made moreapparent from the following description taken in conjunction with theaccompanying. drawings.

SUMMARY OF THE INVENTION

An endoscopic surgical instrument is disclosed for use in a wide varietyof roles including grasping, dissecting, clamping, or retractingmaterials or tissue during surgical procedures performed within apatient's body and particularly within the abdominal cavity.

The surgical instrument of the subject invention includes a handleportion having a fixed handle, and an endoscopic portion which dependsfrom the handle portion. The endoscopic portion includes an elongatedtubular section and an articulating section which is pivotally connectedadjacent to the distal end of the tubular section. Tool means areoperatively connected to the articulating section of the endoscopicportion. A linkage mechanism is associated with the endoscopic portionof the instrument for selectively pivoting the articulating section inan angular plane relative to the longitudinal axis of the tubularsection within about a 90° sector of rotation. This linkage mechanism ispreferably controllable form the handle portion of the instrument.

In one embodiment of the subject invention, the surgical instrument mayinclude a handle portion having a fixed handle and a pivoting handle. Acable extends from the pivoting handle through the endoscopic portion tothe tool means. In this embodiment, the tool means may comprise a pairof cooperating jaws, the movement of which is controlled by operatingthe pivoting handle.

The linkage mechanism for pivoting the articulating section of theendoscopic portion preferably may include an elongated push rodextending from the handle portion, through the endoscopic portion. Thepush rod wold be connected to a link member, which, in turn may bepivotally connected to the articulating section of the endoscopicportion. In addition, the linkage mechanism may include a reciprocatingmember having a gear rack disposed adjacent to the handle portion of theinstrument in cooperation with the proximal end of the elongated pushrod. The gear rack member would be movable in an axial direction inresponse to rotation of an annular pinion gear in the handle portion ofthe instrument. Rotation of the pinion gear would cause the gear rackmember to translate coaxially, causing the push rod to move, and therebycausing the articulating section of the endoscopic portion to pivotwithin 90° sector of rotation relative to the longitudinal axis of theendoscopic portion of the instrument.

Preferred embodiments of the subject invention may also include meansfor rotating the endoscopic portion of the surgical instrument about thelongitudinal axis thereof. In this instance, an annular bushing, whichmay be concentrically disposed within an annular cuff, would be providedin the handle portion of the instrument. The proximal end of theendoscopic portion of the instrument would be arranged within thebushing and would be rotatable about its longitudinal axis by rotatingthe annular cuff.

In another embodiment of the subject invention, the surgical instrumentmay include a handle portion configured as a pistol-grip and anendoscopic portion including an elongated fixed tubular section whichdepends from the handle portion and an articulating section pivotallyconnected to the fixed section adjacent the distal end thereof. Anelongated paddle tool would depended from the articulating section ofthe endoscopic portion for performing retraction tasks during surgicalprocedures. In addition, a linkage mechanism would then be associatedwith the endoscopic portion of the instrument for pivoting thearticulating section relative to the longitudinal axis of the fixedsection, with a 90° sector of rotation. The instrument could also beprovided with means for rotating the endoscopic portion thereof aboutits longitudinal axis.

In yet another embodiment of the subject invention, the surgicalinstrument includes an axial handle portion from which extends anelongated endoscopic portion having an articulating distal section. Aretractor assembly is operatively associated with the articulatingsection and may include a pair of cooperating atraumatic retractor rodmembers or alternatively, a plurality of interleaved retractor blademembers. In both instances, the retractor assembly is manipulatedbetween a closed position and an open position by a driving assemblyhoused in the handle portion of the instrument.

The driving assembly includes a rotatable knob member which isthreadably connected to an axially advanceable screw member. Rotation ofthe knob member will cause corresponding axial movements of the screwmember relative to the handle portion. This arrangement also permitscontrolled deployment of the retractor rods or interleaved retractorblades into a variety of intermediate positions between the open andclosed position depending upon the specific retraction task at hand.Connective means extend from the screw member to the retractor assemblyfor translating the axial movement of the driving assembly to theretractor assembly. Also, in both instances, the articulating section ofthe endoscopic portion of the surgical instrument is manipulated withinan angular degree of rotation by a camming assembly which is associatedwith the handle portion thereof. The camming assembly includes a cammember which is movable between a proximal position and a distalposition with respect to the handle portion of the instrument. Linkagemeans interconnects the cam member with the retractor assembly fortranslating axial movement of the cam member to the retractor assembly.

In still another embodiment of the subject invention, the surgicalinstrument comprises a retractor assembly which is operativelyassociated with the articulating portion of the apparatus and whichincludes a plurality of interleaved retractor blades each having adistal portion which depends angularly therefrom to define an atraumaticsurface. Preferably, each of the retractor blades have a distinct lengthfor promoting efficient stacking or nesting of adjacent blades when theretractor assembly is in the closed position. In addition, theinstrument includes a rotator assembly which is associated with thehandle portion for remotely effectuating the articulation of the distalportion of the apparatus. The rotator assembly includes a knob memberthreadably associated with a longitudinally translating drive screwwhich is interconnected to the articulating portion of the apparatus byan elongated control shaft. Gradual manipulation of the rotator knobwill effectuate corresponding progressive articulation of the distalportion of the apparatus within an angular sector of rotation toincrease the range of operability of the instrument.

In an alternative embodiment of the bladed retractor instrument of thesubject invention, spacer means are disposed between adjacent retractorblades for maintaining clearance therebetween so as to inhibit tissuedamage during actuation of the retractor assembly. In addition, clutchmeans are associated with the driving assembly of the instrument toprevent over-rotation of the knob member during actuation of theretractor assembly. Preferably, the clutch means comprises a ratchetmechanism configured for controlling the axial rotation of the drivingassembly of the instrument.

Further features of the subject invention will become more readilyapparent from the following derailed description of the invention takenin conjunction with accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred embodiments of the subject invention will be describedhereinbelow with reference to the drawings, wherein:

FIG. 1 is a perspective view of an articulating endoscopic surgicalinstrument in accordance with a preferred embodiment of the subjectinvention;

FIG. 2 is an exploded view of the articulating endoscopic surgicalinstrument of FIG. 1;

FIG. 3 is a side cross-sectional view taken along line 3--3 of FIG. 1illustrating the handle portion of the endoscopic instrument;

FIG. 4 is a side cross-sectional view taken along line 4--4 of FIG. 1illustrating the distal end of the endoscopic surgical instrument;

FIG. 5 is a top plan view cross-section view taken along line 5--5 ofFIG. 4;

FIG. 6 is a side cross-sectional view of the distal end of theendoscopic surgical instrument showing the jaws in a closed position;

FIG. 7 is a side cross-sectional view showing, in solid and in phantomlines, the various pivoting movements of the articulating section of theendoscopic portion of the surgical instrument shown in FIG. 1;

FIG. 8 is an enlarged side cross-sectional view of the distal end of theendoscopic surgical instrument taken along line 8--8 of FIG. 7;

FIG. 9 is an enlarged side cross-sectional view of the distal end of theendoscopic surgical instrument illustrating the various positions of thepinon gear which comprises a portion of the linkage mechanism of thesubject invention;

FIG. 10 is a front cross-sectional view taken along line 10--10 of FIG.9;

FIG. 11 is a side cross-sectional view illustrating an alternativeembodiment of the tool head of the endoscopic surgical instrument of thesubject invention in an open position.

FIG. 12 is a top cross-sectional view taken along line 12--12 of FIG.11;

FIG. 13 is a side cross-sectional view of the tool head shown in FIG. 11in a closed position.

FIG. 14 is a side cross-sectional view showing, in a solid and inphantom lines the pivotal movements of the articulating section of theendoscopic portion of the subject invention with the alternateembodiment of the tool head shown in FIGS. 11-13;

FIG. 15 is a front cross-sectional view taken along line 15--15 of FIG.14;

FIG. 16 is a perspective view of an alternate embodiment of the subjectinvention which includes an articulating paddle for performingretraction tasks;

FIG. 17 is a side cross-sectional view taken along line 17--17 of FIG.16;

FIG. 18 is a side cross-sectional view taken along line 18--18 of FIG.16;

FIG. 19 is a side cross-sectional view taken along line 17--17 of FIG.16;

FIG. 20 is a perspective view of another embodiment of the articulatingendoscopic surgical instrument of the subject invention;

FIG. 21 is an exploded view of the articulating endoscopic surgicalinstrument of FIG. 20;

FIG. 22 is a perspective view of another embodiment of the articulatingendoscopic surgical instrument of the subject invention adapted forgynecological procedures;

FIG. 23 is an exploded perspective view of the articulating endoscopicsurgical instrument of FIG. 22;

FIG. 24 is a side cross-sectional view of the endoscopic surgicalinstrument of FIG. 22 with the retractor assembly thereof in a closedposition;

FIG. 25 is a side cross-sectional view of the endoscopic surgicalinstrument of FIG. 22 with the retractor assembly thereof in an openposition;

FIG. 26 is a side cross-sectional view of the endoscopic surgicalinstrument of FIG. 22 with the distal end portion thereof disposed in anarticulated position;

FIG. 27 is a perspective view of yet another embodiment of theendoscopic surgical instrument of the subject invention;

FIG. 28 is an exploded perspective view of the articulating endoscopicsurgical instrument of FIG. 27;

FIG. 29 is a top cross-sectional view of the articulating endoscopicsurgical instrument of FIG. 27 with the retractor assembly thereof in aclosed position;

FIG. 30 is a top cross-sectional view of the articulating endoscopicinstrument of FIG. 27 with the retractor assembly thereof in an openedposition;

FIG. 31 is a side cross-sectional view of the articulating endoscopicinstrument of FIG. 27;

FIG. 32 is a side cross-sectional view of the articulating endoscopicsurgical instrument of FIG. 27 with the distal end portion thereofdisposed in an articulated position;

FIG. 33 is a side cross-sectional view of an endoscopic surgicalinstrument of the present invention equipped with a removable cervixseal;

FIGS. 34 and 35 are side cross-sectional views of an endoscopic surgicalinstrument of the present invention having fluid injection structure andan articulating sleeve cover;

FIG. 36 is a perspective view of another embodiment of the endoscopicsurgical instrument of the subject invention;

FIG. 37 is a perspective view of still another embodiment of theendoscopic surgical instrument of the subject invention;

FIG. 38 is an exploded view of the endoscopic surgical instrument ofFIG. 37;

FIG. 39 is an exploded view of an alternative embodiment of theendoscopic surgical instrument of FIG. 37; and

FIG. 40 is a partial cross-sectional view of the blade attachmentportion of the endoscopic surgical instrument of FIG. 39.

FIG. 41 is a cross-sectional view taken along line 41--41 of FIG. 37illustrating the relative displacement of each of the blade members ofthe retractor assembly.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

The articulating endoscopic surgical instrument of the subject inventionis illustrated in FIG. 1 and is designated generally by referencenumeral 10. Surgical instrument 10 comprises a handle portion 12including a fixed handle 14 and a pivoting handle 16. An endoscopicportion 18 extends orthogonally from handle portion 12 and includes anelongated fixed tubular section 20 and an articulating section 22. Thearticulating section 22 is pivotal connected to the fixed section 20 bya pin 24 disposed adjacent the distal end 26 of section 22. A tool head28 having cooperating jaws 30, 32 depends from the articulating section22 and may be formed in a wide variety of configurations includinggraspers, dissectors, or clamps.

Turning to FIG. 2, the handle portion 12 and the associated fixed handle14 comprises complimentary sections 24 and 36 which are mounted to oneanother by a plurality of bosses 38 formed on section 34. The pluralityof bosses 38 are arranged for engagement in corresponding apertures (notshown), which are formed in section 36 of handle portion 12. Inaddition, each of the complimentary sections 34, 36 of handle portion 12are formed with a portion of a stepped bore 40 which is provided thereinfor accommodating various components of the subject invention, all ofwhich will be described in greater detail hereinbelow. Stepped bore 40includes a circumferential flange 41 for securing the tubular section 20of endoscopic portion 18 in handle portion 12.

The fixed tubular section 20 of endoscopic portion 18 is formed with alongitudinal slot 42 extending proximally from the distal end 26thereof. Slot 42 is particularly adapted for enabling the pivotalmovement of articulating section 22 about pivot pin 24. An aperture 44is provided adjacent distal end 26 for maintaining the pivot pin 24.Pivot pin 24 is provided with a transverse diverging bore hole 25, whichis best seen in FIG. 4. A circumferential groove 45 is formed in thetubular section 20 adjacent the proximal end 27 thereof for enablingtubular section 20 to be securely mounted in the stepped bore 40 ofhandle portion 12.

The tool head 28 which depends from articulating section 22 includescooperating jaws 20, 32, shown here in a clamp configuration. Jaws 30,32 pivot about a pin 46 which passes through apertures 48, 50 in jaws30, 32, respectively and through aperture 52 formed in articulatingsection 22. Jaws 30, 32 also include camming slots 53, 54 respectivelyformed in the proximal ends thereof for receiving a camming pin 55. Pin55 is mounted in a yoke 56 and is adapted for reciprocal coaxialmovement within the fixed section 20 of endoscopic portion 18. Aflexible cable 58 having opposed proximal and distal ends 60 and 52 ismounted, at the distal end 62 thereof, to yoke 56, and at the proximalend 60 thereof, to the distal end 64 of a plunger member 66. Plungermember 66 includes a head portion 68 which is retained in a pivotal clipassembly 70 having opposed complimentary sections 72 and 74. Opposedclip sections 72 and 74 are mounted to one another and are disposedwithin a port 76 formed in the pivoting handle 16 of handle portion 12.Movements of pivoting handle 16 thus causes corresponding coaxialmovements of plunger member 66.

Referring now to FIGS. 2 and 3, the endoscopic surgical instrument 10 ofthe subject invention further includes a linkage assembly which isassociated with the endoscopic portion 18 and handle portion 12 forpivoting the articulating portion 22 thereof. The linkage assemblyincludes an elongated push rod 78 having opposed proximal and distalends 80 and 82, with the proximal end 80 thereof being formed with anaperture 84 for receiving a pin 86. In addition, rod 78 includes amounting flange 88 provided on the distal end 72 thereof which includean aperture 90 for receiving a pin 92. Pin 92 functions to pivotallyconnect a link rod 94 to mounting flange 88 through an aperture 96disposed in the proximal end of link rod 94. Link rod 94 is providedwith an aperture 98 in the distal end thereof, through which a pin 100extends to be pivotally mounted in an aperture 102 which is provided inarticulating section 22 of endoscopic portion 18. The linkage mechanismof the subject invention further includes an elongated gear rack member104 which is capable of being reciprocated in an axial direction. Gearrack member 104 which is capable of being reciprocated in an axialdirection. Gear rack member 104 is formed with circumferential gearteeth 106 and an axial bore 107 which is provided to permit flexiblecable 58 to extend through so as to reach plunger member 66. Gear rackmember 104 is further provided with a mounting flange 108 having anaperture 109. Pin 86 extends through aperture 109 and is mounted inaperture 84 so as to connect rack member 104 to the proximal end 80 ofpush rod 78. An annular pinion gear 110 is mounted on a shaft 112associated with handle portion 12. Pinion gear 110 meshes with thecircumferential gear teeth 106 on rack member 104. Rotation of piniongear 110 is achieved by rotating a pair of opposed wing members 114 and116 which are mounted on the opposed ends of shaft 112.

The endoscopic surgical instrument 10 of the subject invention furthercomprises a mechanism for rotating the endoscopic portion 18 about itslongitudinal axis relative to handle portion 12. This mechanismcomprises an annular bushing 120 that is concentrically mounted within arotatable collar 122 mounted within the stepped bore 40 formed in handleportion 12. Bushing 120 is maintained against collar 122 by a coiledspring 124 disposed in a section of bore 40. Spring 124 acts to biasbushing 120 toward the proximal end of the surgical instrument 10. Theproximal end 27 of fixed section 20 of endoscopic portion 18 extendsthrough bushing 120 and is mounted therein for rotation.

Referring to FIGS. 3-6, the operation of the cooperating jaws 30 and 32of tool head 28 is accomplished by moving the pivoting handle 16 asshown in FIG. 3. Upon moving the pivoting handle 16, the head 68 ofplunger member 66 travels axially causing cable 58 to translate. Inorder to close the cooperating jaws 30 and 32, which are normally openas illustrated in FIG. 4, the pivoting handle 16 is squeezed by thesurgeon, thereby causing the plunger member 66 to pull cable 58 in aproximal direction. The movement of cable 58 causes a correspondingaxial movement of yoke 56, as shown by the indicator arrow in FIG. 6. Inparticular, the movement of yoke 56 causes pin 55 to cam proximallywithin slots 53 and 54 of jaws 30 and 32 respectively, so as to causejaws 30 and 32 to close. Turning now to FIGS. 7-10, the pivotingmovement of the articulating section 22 of endoscopic portion 18 isaccomplished by rotating wing members 114 and 116 to a desired angularposition. More particularly, a detent engaging member 118 is coaxiallymounted on shaft 112 along with wing members 114 and 116 which canrotatably engage in various predetermined positions indicated on handleportion 12 which correspond to 30°, 60°, or 90° of rotation dependingupon the surgical procedure being preformed.

To pivot the tool head 28 angularly with respect to the longitudinalaxis of the endoscopic portion 18, the wing members 114 and 116 arerotated in a counter clockwise direction. This counter-clockwiserotation causes pinion gear 110 to rotate on shaft 112 in acounter-clockwise direction. Simultaneously, gear rack member 104advances proximally within stepped bore 40 causing the elongated pushrod 78 to advance proximally along the longitudinal axis of endoscopicportion 18. Link member 94 is pulled in a generally proximal direction,a shown by the indicator arrow running parallel to link member 94 inFIG. 7, causing the articulating section 22, and the associated, toolhead 28, to pivot in an angular direction about pin 24. Once thearticulating section 22 is in a desired angular position relative to thelongitudinal axis of endoscopic portion 18, the cooperating jaws 30 and32 may be opened or closed by operating the pivoting handle 16 in handleportion 12 as discussed previously.

Turning now to FIGS. 11-15, an alternate embodiment of the tool head 28of the endoscopic surgical instrument 10 of the subject invention isillustrated. In this embodiment, the tool head 28 includes cooperatingdissector jaws 150, 152 which are pivotally mounted on the articulatingsection 22 of endoscopic portion 18. Furthermore, dissector jaws 150,152 are provided with camming slots 154, 156 respectively formed in thedistal ends thereof. As in the preferred embodiment, camming pin 55 isaccommodated within slots 154, 156 and slides in response to axialmovements of yoke member 56 when the pivoting handle 16 is operated toopen and close jaws 150 and 152.

Referring to FIGS. 14 and 15, when link rod 94 is moved in a generallyproximal direction, tool head 28 pivots relative to the longitudinalaxis of endoscopic portion 18. Upon reaching a desired angular position,the cooperating dissector jaws 150 and 152 may be opened or closed byoperating pivoting handle 16 of handle portion 12. Moreover, whenpivoting handle 16 is operated, cable 58, which extends through thediverging bore 25 formed in pivot pin 24, pulls on yoke member 56causing pin 55 to slide within slots 154 and 156, thereby opening orclosing the dissector jaws 150 and 152.

Turning now to FIG. 16, an alternate endoscopic surgical instrument 200of the subject invention is illustrated. Surgical instrument 200comprises a handle portion 202 configured as a pistol-grip, and anendoscopic portion 204. Endoscopic portion 204 includes a fixed tubularsection 206 having opposed distal and proximal ends 208 and 210, and anarticulating section 212 which is pivotally connected to the fixedsection 206 by a pivot pin 214 disposed adjacent to the distal end 208thereof. Surgical instrument 200 further comprises an elongated paddle216 which depends from articulating section 212 and which is intendedfor use as a retractor tool during surgical procedures.

An electrocautery connecter 213 is provided and extends from the handleportion 202 for cauterization of tissue at the surgical site during thesurgical procedure. The connector 213 is in electrical connection withthe tool 216. In order to protect the surgeon who is using the devicefrom electrical shock, the handle 202 is preferably constructed of arigid non-conducting material which renders the apparatus lightweightand electrically insulated.

Referring to FIG. 17, surgical instrument 200 is provided with a linkageassembly that is similar to the assembly provided in the preferredembodiment of the subject invention. It comprises an elongated push rod218 which is pivotally connected to a link member 220 by a pin 222. Linkmember 220 is pivotally connected to articulating section 212 by a pin224. Referring to FIG. 18, the linkage assembly also includes an annularpinon gear 226 which is mounted for rotation on a shaft 228 provided inhandle portion 202. Wing members 230 are coaxially mounted on shaft 228for rotating pinon gear 226. Pinon gear 226 meshes with a reciprocatinggear rack member 232 disposed within the stepped bore 234 which isformed in handle portion 202. Furthermore, gear rack member 232 isconnected to elongated push rod 218.

Surgical instrument 200 also includes an assembly for rotating theendoscopic portion 204 about its longitudinal axis. The rotatingassembly includes an annular collar 236 which is disposed within a port238 formed in bore 234, and an annular bushing 240 concentricallydisposed within the annular collar 236. Bushing 240 is provided foraccommodating the proximal end of endoscopic portion 206, which ismounted therein for rotation. A coiled spring 242 is disposed withinstepped bore 234 for biasing bushing 240 in a proximal direction so asto maintain it within collar 236.

Referring now to FIG. 19, to lower the retractor paddle 216 into aposition parallel to the longitudinal axis of endoscopic portion 204,the wing members 230 are rotated in a clockwise direction. Thisclockwise rotation of wing members 230 causes a clockwise rotation ofpinion gear 226 about shaft 228. Consequently, gear rack member 232 iscaused to advance distally along the axis of endoscopic portion 204.Push rod 218 advances distally within the fixed section 206 ofendoscopic portion of 204. Upon advancing, push rod 218 causes linkmember 220 to move in a generally distal direction, thereby causingpaddle 216 to pivot downwardly, as shown by the indicator arrow in FIG.19.

Turning to FIGS. 20 and 21, an alternative endoscopic surgicalinstrument 300 of the subject invention is illustrated. Surgicalinstrument 300 is structurally similar to the preferred embodiment ofthe subject invention. However, the range of operability of the toolhead 28 of surgical instrument 300 is distinct in that it can be pivotedin a horizontal plan with respect to the endoscopic portion 18 ofsurgical instrument 300.

In this embodiment, the components and function of the linkage assemblyremains essentially the same as in the preferred embodiment. Inparticular, annular pinion gear 110 which is mounted on a shaft 112 inhandle portion 12, meshes with the circumferential gear teeth 106 ofgear rack member 104. The proximal end 80 of the elongated push rod 78is pivotally connected to the flange 108 of gear rack member 104 and thedistal end 82 of the elongated push rod 78 is pivotally connected tolink member 94 by a pin 92. The linkage assembly of surgical instrument300 is operatively connected to an articulating section 302.Articulating section 203 includes a slotted distal portion 304 and aproximal portion 306 having a bore 308 for receiving pivot pin 24. Acleat 310 extends outwardly from the proximal portion 306 ofarticulating section 302 and includes an aperture 312 for receiving apivot pin which connects the link member 94 to the articulating section302.

To pivot the tool head 28 angularly, in a horizontal plane, with respectto the longitudinal axis of the endoscopic portion 18, the wing members114 and 116 are rotated. Simultaneously, gear rack member 104 advanceswithin stepped bore 40 causing the elongated push rod 78 to advancealong the longitudinal axis of endoscopic portion 18. Movement of theelongated push rod 78 causes link member 94 to pivot in such a manner soas to cause the articulating section 302, and the associated tool head28, to pivot in an angular direction about pivot pin 24. Once thearticulating section 302 is in a desired angular position relative tothe longitudinal axis of endoscopic portion 18, the cooperating jaws 30and 32 may be operated by manipulating the pivoting handle 16 in handleportion 12 as discussed hereinabove.

Referring to FIG. 22, another endoscopic surgical instrument 400 of thesubject invention is illustrated which may be used as a retractor duringgynecological procedures and particularly as an intrauterine retractor.Surgical instrument 400 comprises a substantially barrel shaped axialhandle portion 402, and an elongated endoscopic portion 404 whichextends outwardly from handle portion 402. Endoscopic portion 404includes a tubular section 406 by a pivot pin 414 adjacent the distalend portion 410 thereof. A retractor assembly 416 is operativelyassociated with the articulating section 412 of endoscopic portion 404and includes a pair of cooperating atraumatic rod members 418 and 420each having cylindrical bodies with blunt heads configured so as not tocause damage to tissue during retraction procedures.

Turning to FIG. 23, the handle portion 402 of surgical retractor 400includes a two-part handle having fight and left mountable hemi-sections422 and 424. Once assembled, the hemi-sections 422 and 424 defined astepped axial bore 426 which extends through the handle portion 402. Theaxial bore 426 has a proximal chamber 428, a primary medical chamber430, a secondary medial chamber 432, a tertiary medial chamber 433, aquaternary medial chamber 434, and a distal chamber 436 defined therein.The handle portion 402 houses, within the axial bore 426, a drivingassembly which manipulates the retractor assembly 4 16, and a cammingassembly which manipulates the articulating section 412 of endoscopicportion 404.

The driving assembly of surgical instrument 400 includes knob member 438and an associated threadably advanceable driving screw member 440. Knobmember 438 comprises a proximal grasping portion 442, an intermediatecavity portion 444, and a distal engaging portion 446. A threaded axialbore 448 extends at least partially through the knob member 438 from thedistal engaging portion 446 thereof to the proximal grasping portion 442where it is capped by a threaded closure member 450. Knob member 438 ismounted within the axial bore 426 of handle portion 402 in such a mannerso that the distal engaging portion 446 thereof is maintained within theprimary medial chamber 430 of axial bore 426 which the intermediatecavity portion 444 is maintained within the proximal chamber 428 ofaxial bore 426. Once mounted, knob member 438 is rotatable about thelongitudinal axis of handle portion 402.

The driving screw member 440 of the driving assembly comprises anelongated threaded body portion 452 having a proximal end portion 454which engages operatively within the threaded axial bore 448 of knobmember 438, and a distal head portion 456 which extends from thethreaded body potion 452 thereof. Lateral slots extend along the bodyportion 452 of screw member 440 for cooperatively engaging protuberances457 projecting radially into the secondary medial chamber 432 of axialbore 426. The engagement of the protuberance 457 within lateral slot 455prohibits rotational movement of screw member 440 when the knob member438 is rotated and in addition, provides guidance for the screw member440 within the axial bore 426.

A bore 458 extends axially into the distal head potion 456 of thedriving screw member 440 for permitting retention of elements ofendoscopic portion 404 therein. A transverse aperture 460 is provided inthe head portion 456 of screw member 440 for accommodating a two-partuniversal locking clip 462, 463 which engages an element of endoscopicportion 404 extending into bore 458. Once mounted within the handleportion 402, the threaded body portion 452 of screw member 440 ismaintained partially within the secondary medial chamber 432 of axialbore 426. Rotations of the knob member 438 relative to the handleportion 402 will cause corresponding axial translation of the drivingscrew member 440 within the secondary medial chamber 432 of axial bore426 in handle portion 402.

The camming assembly for manipulating the articulating section 412 ofendoscopic portion 404 includes a cylindrical cam follower having rightand left, hemi-portions 464 and 466 mountable to one another by bossessuch as, for example, boss 468 on fight hemi-portion 464. An axialpathway 470 is formed in the cylindrical cam follower 464, 466 foraccommodating elements of endoscopic portions 404. In particular, anannular groove 471 is formed therein for engagement purposes. A camfollower post 472 projects radially outward from the periphery of lefthemi-potion 466 and travels within cam slot 474 formed in the lefthemi-section 422 of handle portion 402. The cam slot 474 is disposedwithin a circumferential groove 476 defined in the outer surface ofhandle portion 402 external from the tertiary medial chamber 433 ofaxial bore 426.

The cylindrical cam follower 464, 466 is adapted and configured to moveaxially and rotatably within the tertiary medial chamber 433 of steppedaxial bore 426 in response to rotation of a two-part manipulating collarhaving right and left hemi-portions 478 and 480 mountable to one anotherby mounting projections, such as, for example, mounting projection 482.An aperture 484 extends radially through hemi-portion 478 of themanipulating collar for receivably engaging the cam follower post 472 soas to operatively interlock the elements of the camming assembly.Rotation of collar 478, 480 will cause cam post 472 to be driven in acam slot 474 causing axial advancement of the camming assembly relativeto the handle portion 402.

The endoscopic portion 404 of surgical instrument 400 extends fromhandle portion 402, and comprises a plurality of coaxial tubular membersincluding an outer tubular member 490 having an axial bore 492 and astepped proximal end which defines a first annular ridge portion 494,and a second annular ridge portion 496 for mounting the endoscopicportion 404 to handle portion 402. The first annular ridge portion 494is maintained in the quaternary medial chamber 434 of axial bore 426,while the second annular ridge portion 496 is maintained in the distalchamber 436 of axial bore 426 for mounting the endoscopic portion 402 tohandle portion 402.

Endoscopic portion 404 also includes an inner tubular member 500 havingan axial passageway 502, and a proximal annular mounting flange 504dimensioned for locking engagement in the annular groove 471 of theaxial bore 470 in cylindrical cam follower 464, 466. An internal controlmember 510 extends through the axial passageway 502 of inner tubularmember 600 and includes an outer sleeve 512, and a central rod 514.Central control rod 514 has a proximal tail portion 516 which isengagable within the distal head portion 456 of screw member 440 by thetwo-part universal clip 462, 463 such that axial translation of screwmember 440, in response to rotations of knob member 438, will causecorresponding axial translation of the center control rod 514 withinendoscopic portion 404. A distal end portion 515 of central control rod5 14 is flexible for permitting operation of the retractor assembly 416when the articulating section 412 is pivoted into an operative position.

The distal end portion 410 of endoscopic portion 404 defines a sleevemember which includes a yoke portion 518 having a longitudinallyextending slot 520 provided therein defining a pair of opposed dependingarms 522 and 524 for accommodating pivotal movement of the articulatingsection 412 relative to endoscopic portion 404. Apertures 526 and 528are respectively provided in the opposed depending arms 522 and 524, anda tail portion 530 extends proximally from the yoke portion 518 thereofwith a circumferential groove 532 provided therein. A tang 534 is formedadjacent the distal end of the outer tubular portion 490 for lockinglyengaging the circumferential groove 532 in tail portion 530 of yokeportion 518 when it is extended into the axial bore 492 thereof toconnect the distal end portion 419 to the remainder of endoscopicportion 404. In addition, an axial passageway of at least the distalportion 515 of central control road 514.

Surgical instrument 400 further comprises a linkage mechanism for movingthe articulating section 412 of endoscopic portion 404 within a definedangular degree of rotation. The linkage mechanism includes a base link540 having a body portion 542 and a tail portion defined by anintermediate circumferential groove section 544 and a proximal annularsection 546. Base link 540 is secured within the axial passageway 502 ofinner tubular portion 500 by a tang 545 formed adjacent the distal endof inner tubular portion 500, and configured for engaging thecircumferential groove section 544 thereof. A central passageway 548extends through base link 540, adjacent the lower edge thereof, foraccommodating a proximal pivot pin 552 which inter links the base link540 with a connective link 554 through a proximal aperture 556 providedtherein. A distal aperture 558 is also provided in connective link 554for accommodating distal pivot pin 560 which is received in acorresponding aperture 562 provided in the proximal portion 564 ofarticulating section 412 adjacent the lower edge thereof, Thus,connective link 554 functions to interlink the articulating section 412to the base link 540 of the linkage mechanism.

The articulating section 412 of endoscopic portion 404 has a centrallydisposed transverse aperture 566 formed in the proximal portion 564thereof for accommodating the main pivot pin 414. A longitudinalaperture 570 extends through the articulating section 412 for permittingextension of the central control rod member 514 therethrough.Articulating section 4 12 further includes opposed depending yoke arms572 and 574 each having an aligned longitudinal cam slots 576 and 578formed therein respectively, for cooperating with a cam follower pin580. In addition, opposed aligned pivot ports 582 and 585 are providedin the lateral yoke arms 572 and 574, respectively.

The cooperating atraumatic retractor rod members 418 and 420 arepivotably connected to the opposed lateral yoke arms 572 and 574 ofarticulating section 412 by engagement of a pivot pin 586 within theopposed pivot ports 582 and 584, and also within corresponding pivotports 588 and 590 provided in the retractor rod members 418 and 420,respectively. Symmetrically disposed angular camming slots 592 and 594are also formed in retractor rod member 418 and 420 respectively, forworking with cam follower pin 580. A transverse bore 596 is provided inpivot pin 586 for permitting of a portion of the distal end 15 ofcentral control rod 514 therethrough, and a transverse bore 598 isprovided in camming pin 580 for receivable engaging a distal end portionof central control rod 514.

The termination of the distal portion 515 of central control rod 514within camming pin 580 achieves complete connectivity between thedriving assembly in handle portion 402 and the retractor assembly 416 ofendoscopic portion 404. Moreover, axial movements of the central controlrod 514, in response to axial translation of driving screw 440, willcause corresponding cooperative movement of the retractor rod members418 and 420 through the translation of camming pin 580 relative to theangular cam slots 592 and 594.

Referring now to FIGS. 24-26, the surgical instrument 400 mayadvantageously be employed as a retractor during gynecologicalprocedures by rotating the knob member 438 counterclockwise (as viewedfrom the proximal end of the instrument) to move the cooperativeretractor rod members 418 and 420 from the closed position of FIG. 24,to the opened position of FIG. 25. More particularly, upon rotating knobmember 438 counterclockwise, the drive screw member 440 will translatein the direction of arrow "C". As screw member 440 retreats, the tailportion 516 of the central control rod 514 is pulled in a proximaldirection causing the camming pin 580, which is fixed to the distal endthereof, to move proximally within the angled camming slots 592 and 594of rod members 418 and 420. Distal movement of camming pin 580 withincamming slots 592 and 594 causes the cooperating retractor rod members418 and 420 to open in the direction of arrow "B". Closure of rodmembers 418 and 420 is achieved through counter rotation of knob member438. Transposition of the rotation from counterclockwise to clockwisefor purposes of deploying the retractor assembly is also with the scopeof the invention.

Turning now to FIG. 26, in operation, the articulating section 412 ofendoscopic portion 404 may be pivoted in the direction of arrow "E"within a vertical plane with respect to the longitudinal axis ofendoscopic portion 404 into various angularly disposed positions. Toachieve this articulated movement, the manipulating collar 476, 478 isrotated clockwise (as viewed from the proximal end of the instrument),causing cylindrical cam follower 466, 468 to rotate concomitantlytherewith. As a cam follower 466, 468 rotates, the cam post 472translates within the cam slot 474 from a first position, best seen inFIG. 24, wherein collar 478 is in its proximal most position withincircumferential groove 476, to a second position, best seen in FIG. 25,wherein collar 478 is in its distalmost position within groove 476. Theaxial translation of cylindrical cam follower 464, 466 causes the innertubular portion 500 of endoscopic portion 404 to move in a distaldirection, since the proximal flange 504 of inner tubular portion 500 isengaged in the groove 471 defined in passageway 470 of cam follower 464,466. As inner tubular portion 504 moves distally, it extends outwardlyfrom the axial bore 535 in the sleeve member defined by the distalportion 4 10 of endoscopic portion 404, such that base link 540 is urgeddistally within the slotted area 520 of distal portion 410. Thereupon,connective link 554 is urged in a generally distal direction, pivotingabout pivot pins 552 and 560, and causing the articulating section 412to be pivoted angularly with respect to the longitudinal axis ofendoscopic portion 404 about the main pivot pin 414.

The angle of vertical translation of articulating section 412 can varydepending upon the degree of rotation of manipulating collar 478. Inaddition, once in an articulated position, the retractor assembly 416can be manipulated independently, since the distal end portion 5 15 ofthe central control rod 514 is substantially flexible, as seen in FIG.26. Transposition of the rotation from clockwise to counterclockwise forarticulating the instrument is also within the scope of the invention.

Turning to FIG. 27, yet another embodiment 600 of the articulatingsurgical retractor of the subject invention is illustrated which may beused endoscopically or during laparoscopic procedures within theabdominal cavity. Surgical instrument 600 comprises an axial handleportion 602, and an elongated endoscopic portion 604 extending from theaxial handle portion 602 and including an elongated tubular section 606,and an articulating distal section 608 pivotably connected to theelongated tubular section 606 adjacent the distal end thereof by a mainpivot pin 610. A retractor assembly 612 is operatively associated withthe articulating section 608 and includes a plurality of cooperativeinterleaved retractor blade members 614, 616, and 618.

Referring to FIG. 28, the handle portion 602 of surgical instrument 600is substantially identical to that of surgical instrument 400. Itcomprises mountable right and left hemi-sections 622 and 624 having astepped axial bore 626 extending therethrough defined by a proximalchamber 628, a primary medial chamber 630, a secondary medial chamber632, a tertiary medical chamber 633, a quaternary medial chamber 634,and a distal chamber 26. The handle portion 602 houses, within the axialbore 626, a driving assembly for manipulating the retractor assembly anda camming assembly for manipulating the articulating section 608 ofendoscopic portion 604.

The driving assembly includes a rotatable knob member 638 and an axiallyadvanceable driving screw 640. Driving screw 640 varies from the drivingscrew 440 of surgical instrument 400 in that it includes a body portion642 having a distal head portion 644 provided with a transverse slot 646for accommodating a transverse planar engaging clip 648. Engaging clip648 is formed with a retention notch 650 for lockingly retaining anoperative element of endoscopic portion 604. The knob member 638 isformed with an internal threaded bore 652 extending at least partiallytherethrough for operatively engaging the driving member 640, and whichis covered by closure member 654.

The camming assembly includes a cylindrical cam follower havingmountable right and left hemi-sections 656 and 658 configured forrotational and axial movement within the tertiary medial chamber 633 ofaxial bore 626. A camming post 660 extends radially outward from theperiphery of left hemi-section 658 and is dimensioned for translatingwithin a cam slot 662 formed in a circumferential groove 664 defined inthe outer surface of handle portion 602 external from the tertiarymedial chamber 633. A rotatable manipulating collar defined by mountableright and left hemi-portions 666 and 668 is configured for being mountedin circumferential groove 664 and includes a port 670 for receivablyengaging the cam post 660 so as to interlock the elements of the cammingassembly. Rotation of manipulating collar 666, 668 will causetranslation of cam post 660 in cam slot 662, and consequent axialtranslation of the cylindrical cam follower 656, 658 along the axialcenter line of the handle portion 602 with the tertiary medial chamber633.

The endoscopic portion 604 of surgical instrument 600 comprises acentral control rod 680 having a tail portion 682 which extends into anaxial bore 684 in driving screw member 640 to be lockingly engagedtherein by the notch 650 in locking clip 648. In doing so, the axialtranslation of the driving screw 640 will cause corresponding axialmovement of the control rod 680. A connective rod 686 is engaged in thedistal end 685 of control rod 680 for interconnecting the retractorassembly 612 with the control rod 680. Connective rod 686 is flexible topermit operation of the retractor assembly 612 when the articulatingsection 608 of endoscopic portion 604 is pivoted into an operativeposition. Endoscopic portion 604 further comprises an inner tubularportion 690 having an annular flange 692 formed on the proximal endthereof. Flange 692 is dimensioned for engagement in a circumferentialgroove 694 formed in the axial bore 696 of the cylindrical cam follower656, 658, such that the inner tubular portion 690 will translate axiallywhen the cylindrical cam follower 656, 658 moves within-the tertiarymedial chamber 633 of axial bore 626.

The inner tubular portion 690 is disposed within the outer tubularportion 698 which is provided for a longitudinally extending slot 700 inthe distal end portion thereof for accommodating the pivotal movementsof articulating section 608. A transverse aperture area 702 is definedadjacent the proximal end 704 of the outer tubular portion 698 forreceiving a radially inwardly projecting stem 706 disposed in the distalchamber 636 of axial bore 626 in handle portion 602. Engagement of stem706 in aperture area 702 achieves fixation of the endoscopic portion 604and the handle portion 602.

A primary yoke member 710 is mountable in the distal end portion of theouter tubular portion 698 which comprises a body portion 712 having apair of opposed lateral yoke arms 714 and 716 depending therefrom anddefining a slotted area 718 therebetween. A circumferential groove 720is provided in the body portion 712 for being engaged by a locking tang722 formed adjacent the slotted area 700 in the outer tubular portion698. Opposed pivot ports, of which 724 is one, are defined in theopposed lateral yoke arms 714 and 716 for accommodating main pivot pin610 which is formed integral with the articulating section 608 ofendoscopic portion 604.

A linkage assembly interlinks the articulating section 608 with theinner tubular portion 690 of endoscopic portion 604. The linkageassembly includes a base link 730 having a body portion 732 from whichextends a proximal tail portion 734 provided with a circumferentialgroove 736. The tail portion 734 is adapted to be extended into thedistal end 738 of inner tubular portion 690 and is maintained therein bya locking tang 740 which is engagable in the circumferential groove 736.An axial bore 742 extends through the base link 730 for permittingpassage of connective rod 686 therethrough. In addition, an aperture 744is provided in the body portion 732 of base link 730, adjacent the upperedge thereof, for receiving a proximal pivot pin 746 which interlinksbase link 730 with a connective link 748 through a proximal aperture 750formed therein. Connective link 748 has a distal aperture 752 forreceiving a distal pivot pin 754 which is provided for interlinkingconnective link 748 with the articulating section 608 of endoscopicportion 604 through an aperture 756 provided in the proximal end portion758 of articulating section 608. Axial translation of the inner tubularportion 690, in response to movement of the camming assembly, will causethe corresponding translation of the base link 730 within the slottedportion 718 of primary yoke member 710, whereby the connective link 748will move generally axially to cause pivoting movement of articulatingsection 608 in a vertical plane relative to the longitudinal axis of theendoscopic portion 604 of surgical instrument 600.

The articulating section 608 of endoscopic portion 602 is formed with aslotted area 760 for accommodating the retractor assembly 612 ofsurgical instrument 600. The retractor assembly 612 includes a secondaryyoke member 762 having opposed upper and lower yoke arms 764 and 766defining a slotted retractor blade maintaining area 768 therebetween.Opposed longitudinally extending guide slots 770 and 772 are provided inupper and lower yoke arms 764 and 766, respectively, as well as opposedpivot apertures 774 and 776, respectively. A guide pin 778 extendsthrough a maintaining aperture 780 in the articulating section 608, andinto the opposed guide slot 770 and 772, while a camming pin 782 extendsthrough the opposed pivot apertures 774 and 776. Guide pin 778 andcamming pin 782 both cooperate with the interleaved retractor blades614, 616, and 618. More particularly, corresponding pivot ports 814, 816and 818 are provided respectively in the interleaved retractor blade614, 616, and 618, for receiving guide pin 778. Retractor blades 614,616 and 618 are made of a suitable surgical material having sufficientstrength for the desired retractor function. Such materials includestainless steel, plastics and/or combinations thereof. Camming slots areprovided in the retractor blades for working with camming pin 782, andinclude an angularly disposed camming slot 824 is formed in retractorblade 614, a longitudinally disposed camming slot 826 is formed inretractor blade 616, and an angularly disposed camming slot 828 isformed in retractor blade 618. Camming slots 824 and 828 are arranged insymmetrical relationship, such that translation of the camming pin 782,in response to movements of secondary yoke member 762, will cause afan-like deployment of the interleaved retractor blades 614, 616, and618.

Referring to FIGS. 29-32, in use, the retractor blade assembly 612 ismoved from the closed position illustrated in FIG. 29, to an openedposition illustrated in FIG. 30, by rotating the knob member 638counterclockwise (as viewed from the proximal end of the instrument) tocause corresponding axial translation of screw member 640 in thedirection of arrow "G", within the axial bore 626 of handle portion 602.As driving screw member 640 retreats, the tail portion 682 of thecentral control rod 680 is pulled proximally, along with the connectiverod 686, the distal end of which is fixedly mounted in the proximal endof secondary yoke member 762. At such a time, the opposed guide slots770 and 772 in secondary yoke member 762 permit relative translation ofsecondary yoke member 762 in relation to the guide pin 778. Furthermore,as the secondary yoke member 762 is drawn in a proximal direction,camming pin 782 translates proximally within the camming slots 824, 826,and 828 of the retractor blades, causing the interleaved retractorblades 614, 616, and 618 to deploy in a fan-like configuration.

Turning now to FIGS. 31 and 32, to pivot the articulating section 608 ofendoscopic portions 604 in the direction of arrow "H" in a verticalplane with respect to the longitudinal axis of endoscopic portion 604during a surgical procedure, the manipulating collar 666, 668 is rotateclockwise (as viewed from the proximal end of the instrument), such thatthe cylindrical cam follower 656, 658 is caused to advance from aproximal position to a distal position with the tertiary medial chamber633 of axial bore 626. At the same time, camming post 660 translateswithin the camming slot 662 formed in the circumferential groove 664 inhandle portion 602. Consequently, the inner tubular portion 690 ofendoscopic portion 604 moves in a distal direction, urging the base link730 distally within the slotted area 718 of primary yoke member 710.Thereupon, connective link 748 is urged in a generally distal direction,causing the articulating section 608 to pivot about main pivot pin 610in a vertical plane relative to the longitudinal axis of endoscopicportion 604. The angle of vertical translation of articulating section608 can vary depending upon the degree of rotation of the manipulatingcollar. Furthermore, while the articulating section 608 is in an angularposition, the retractor assembly may be actuated independently, sincethe connective rod 686 is substantially flexible, as seen in FIG. 32.

FIG. 33 shows an endoscopic surgical retractor 600 substantially thesame as that shown in FIGS. 27-32. This retractor 600 is particularlyadapted for use in gynecological surgery involving the cervix or uterus.An annular cervical seal 850 is removably disposed on endoscopic portion604 intermediate the axial handle portion 602 and the articulatingdistal section 608. This cervical seal 850 assists in preventing theegress of insufflation gases from the uterus during retractormanipulations.

In use, the uterus is insufflated and the retractor is inserted to apoint wherein the cervical seal 850 is adjacent the cervix of thepatient. In this position the cervical seal 850 inhibits the flow ofinsufflation gas from the uterus around the exterior of the endoscopicportion 604 of the instrument 600.

FIGS. 34 and 35 show two alternative embodiments of the endoscopicsurgical retractor in accordance with the present invention. Theseretractors are specifically designed and adapted for gynecologicalapplications and include atraumatic upper and lower blades 852, 854configured in a streamlined semicircular cross section. In the retractedconfiguration, the blades interleave to form a smooth rounded retractorassembly for atraumatic insertion, particularly when used without acannula port.

The endoscopic surgical retractors shown in FIGS. 34 and 35 are alsoprovided with a sleeve 856 extending around the distal end of theendoscopic portion 604 and the proximal end of the articulating portion608. This sleeve 856 serves to enclose and protect the articulatinglinkages from external contamination. Also, the sleeve 856 preventstissue or organs from becoming entangled in the linkages duringoperation. The sleeve 856 is preferably formed of an elastic or silasticmaterial capable of moving with the articulating portion 608.

Referring specifically to FIG. 34, the endoscopic surgical retractorincludes an injection port 858 disposed adjacent a distal end of thehandle portion 602. The injection port 858 communicates with theinterior of the endoscopic portion 604 to permit fluid to be injectedtherethrough into the surgical site. The injection port 858 of theretractor in FIG. 34 comprises a substantially inverted "T" structureproviding direct access to the passages in the endoscopic portion 604.This structure may advantageously be used for fluid irrigation ormedication of the operative site. Alternatively, the port may be used toadminister dyes or marker substances intravaginally such as, forexample, radiopaque dyes injected to determine the patency of thefallopian tubes, etc. Where a surgical retractor having an injectionport feature is to be used in an insufflated cavity, valve 866 ispositioned in line to inhibit insufflation gases from exiting the cavitythrough the port.

The endoscopic surgical retractor of FIG. 35 is substantially the sameas the retractor of FIG. 34 except that the injection port 860communicates with a plurality of distribution ports 862 through tube 864disposed coaxially in endoscopic portion 604. This configuration allowsfor more accurate delivery of fluids and may even be used to administerpressurized aerosols therethrough.

Referring to FIG. 36, another embodiment of an endoscopic surgicalretractor 900 is illustrated, which includes an axial handle portion902, an elongated tubular body 904 extending longitudinally from thehandle portion 902, and an articulating portion 906 pivotably connectedto the tubular body 904 at a distal end thereof by a transverse pin 908.A pair of retractor blades 910 and 912 are operatively associated withthe articulating portion 906 of surgical instrument 900 and are adaptedto move between an open position and a closed position through remotemanipulation of a proximal knob member 914 disposed at the proximal endof handle portion 902. Retractor blades 910 and 912 have a substantiallyC-shaped transverse cross-sectional configuration defining atraumaticsurfaces for manipulating tissue during gynecological procedures.

A cervical seal 915 of frusto-conical configuration is provided on thearticulating portion 906 of surgical apparatus 900 adjacent the distalend of the tubular body 904. The cervical seal 915 functions to inhibitthe egress, from the uterus, of insufflation gas, or fluid introducedinto the uterus through an irrigation system originating at an inletport 916 which extends longitudinally from the proximal end of handleportion 902. Surgical instrument 900 also includes a mechanism forprogressively articulating the distal portion 906 thereof which iseffectuated by remote manipulation of a distal knob member 918,hereinafter more fully described.

Turning to FIGS. 37 and 38, yet another embodiment of the surgicalinstrument of the subject invention is illustrated and is designatedgenerally by reference numeral 1000. Surgical instrument 1000 comprisesan axial handle portion 1010 having opposed hemi-portions 1012 and 1014mountable to one another to define an enclosure for housing a mechanismfor remotely moving a retractor blade assembly 1016 between an openposition and a closed position, and a second mechanism for progressivelyarticulating the distal portion 1018 of the endoscopic tubular body 1020within an angular sector of rotation relative to a longitudinal axis oftubular body 1020 about a pivot pin 1025.

The mechanism for moving the retractor blade assembly 1016 between anopen position and a closed position comprises an axial drive screw 1022disposed within handle portion 1010 and having an elongated threadedbody portion 1024 operatively connected to a rotator member 1026 whichis manipulated by a proximal knob member 1028. An elongated control rod1030 is mounted to the distal portion 1032 of axial drive screw 1022 bya C-shaped clip 1033 and extends through the tubular body 1020 ofapparatus 1000 for transmitting longitudinal movement of the axial drivescrew to a flexible control wire 1034 adapted to bend as the instrumentis articulated. A coupling 1038 extends from the distal end of controlwire 1034 for operatively interlinking the retractor blade assembly 1016to the manipulation mechanism of surgical apparatus 1000. Thus,manipulation of the proximal knob member 1028 will cause rotator member1026 to turn, thereby urging drive screw 1024 to translate axiallyrelative to handle portion 1010. Consequently, control rod 1030 willtranslate longitudinally within tubular body 1020, moving the retractorassembly 1016 between an open and closed position.

The retractor blade assembly 1016 of surgical instrument 1000 comprisesa plurality of interleaved cooperating retractor blades including firstthrough fifth retractor blades 1041, 1042, 1043, 1044, and 1045. Byproviding additional blades, any gaps between the blades at the proximalend are smaller, and thus tissue is less likely to penetrate the areaintermediate the blades. In addition, as best seen in FIG. 41, theblades of retractor assembly 1016 are arranged in a steppedconfiguration descending from the first retractor blade 1041 to thefifth retractor blade 1045. This stepped arrangement provides a smoothretraction surface and promotes blade flexure to enhance tissue releaseduring a surgical procedure.

Each blade of the retractor assembly 1016 has an angularly dependingdistal portion 1046 which has a texturized cover provided thereon fordefining an atraumatic surface suitable for manipulating tissue ororgans within the abdominal cavity. Alternatively, the distal portion1046 may be stamped out to define the atraumatic surface. This will alsoincrease the rigidity of the blade and it will thicken the perimeter anddistalmost portions thereof. In the closed position, the first throughfifth blades of retractor assembly 1016 are stacked in a nestedconfiguration to facilitate insertion and removal of the instrumentthrough a trocar or cannula device. To promote effective stacking of theblades in the closed position, each blade of the retractor assembly 1016is of a distinct length so that the angularly depending portions thereofnest with one another. Center blade 1043 is the longest of the blades ofretractor assembly 1016, and includes a downturned tail portion 1048formed with a slot 1050 for engaging coupling member 1038. Furthermore,each blade of retractor assembly 1016 is provided with a cam slot 1052,with that of the center blade 1043 being disposed parallel to thelongitudinal axis thereof, while the respective cam slots 1052 of theouter blades of retractor assembly 1016 are disposed angularly withrespect to the longitudinal axis of the blades, thereby effectuating afan-like deployment of the retractor assembly 1016 as it is moved from aclosed position to an open position. A transverse cam pin 1054 ismounted within the distal portion 1018 of surgical apparatus 1000 andextends through each of the cam slots 1052 for camming the blades ascenter blade 1043 is caused to translate longitudinally in response toaxial movements of control rod 1030. Pivot apertures 1056 are formed atthe proximal end of each blade of retractor assembly 1016 for receivinga pivot pin 1058 which operatively associates the plurality ofinterleaved retractor blades.

The mechanism for remotely articulating the distal portion 1018 of thetubular body 1020 of surgical instrument 1000 relative to thelongitudinal axis thereof includes a distal knob member 1060 which isassociated with the handle portion 1010 and which has a threadedinternal passageway for receiving a cooperating axial drive member 1062.Drive member 1062 is provided with an external threaded portion 1064 anda nipple 1066 which extends distally therefrom for mounting an elongatedcontrol shaft 1068 which transmits the longitudinal motion of drivemember 1062 through tubular body 1020. The proximal end of control shaft1068 extends through a clevis 1070 which is maintained within the distalend of tubular body 1020, to a base link 1072 having a nipple 1074extending proximally therefrom for mounting the distal end of controlshaft 1068. A longitudinal passageway 1076 extends through base link1072 for accommodating control wire 1034 and a link member 1080interconnects base link 1072 to the articulating distal portion 1018.Link member 1080 is mounted to base link 1072 by a pivot pin 1082, andto the articulating distal portion 1018 by a pivot pin 1084. Clevismember 1070 is provided with an aperture 1086 for receiving the pivotpin 1025 which is associated with the articulating distal portion 1018.A sleeve 1090 covers the distal portion 1018 of surgical apparatus 1000for protecting the internal structures thereof. In addition, a primaryannular seal member 1092 is associated with the distal end of controlshaft 1068 for forming a seal between the control shaft 1068 and tubularbody 1020 to inhibit the egress of insufflation gas through theendoscopic portion of surgical apparatus 1000. Similarly, a secondaryannular seal member 1094 is associated with the distal end of controlrod 1030 for forming a seal between the control rod 1030 and the tubularcontrol shaft 1068.

In operation, progressive articulation of the distal portion 1018 ofsurgical apparatus 1000 is achieved through gradual rotation of distalknob member 1060 which causes corresponding axial translation of drivemember 1062 within handle portion 1010, driving control shaft 1068distally with respect to tubular body 1020. Consequently, base link 1072is translated in a distal direction causing link member 1080 to pivot,urging the distal portion 1018 of surgical instrument 1000 into adesired articulated position, thus increasing its range of operability.

Turning now to FIGS. 39 and 40, an alternative embodiment of surgicalinstrument 1000 is illustrated in which structure is provided formaintaining clearance between retractor blades 1041, 1043, and 1045 ofretractor assembly 1016 to inhibit the entrapment of tissuetherebetween. This safety structure includes first and second annularspacers 1102 and 1104. The first annular spacer 1102 is disposed betweenretractor blades 1041 and 1043, while the second annular spacer 1104 isdisposed between retractor blades 1043 and 1045. In use, when theretractor blades are moved from an open position to a closed position,the annular spacers will substantially reduce the likelihood that tissuewill become trapped and/or damaged by pinching.

Another feature of surgical apparatus 1000 comprises a clutch mechanismincorporated into the axial driving assembly for inhibitingover-rotation of the axial drive screw 1022. In addition, the clutchmechanism serves to limit the mechanical forces resulting from operatingaxial drive screw 1022 which can damage tissue if it becomes entrapperbetween the retractor blades of retractor assembly 1016. The clutchmechanism includes a distal control collar 1106, a coiled biasing spring1108, and a proximal control collar 1110. Distal control collar 1106 isthreadably associated with driving screw 1022 and is provided withratchet teeth 1112 extending rearwardly therefrom to interactoperatively with corresponding ratchet teeth 1114 which extend forwardlyfrom proximal control collar 1110. Proximal control collar 1110 isengaged within rotator knob 1028 so as to rotate therewith duringactuation of retractor assembly 1016. Biasing spring 1108 maintains thespacial relationship between distal control collar 1106 and proximalcontrol collar 1110 so as to ensure an intermeshed relationship betweenratchet teeth 1112 and 1114. In operation, when a predeterminedrotational force is exerted upon the axial driving assembly, the ratchetteeth 1112 and 1114 will slip past one another to prevent over-rotationand/or tissue damage.

The endoscopic surgical instrument of the subject invention is compact,lightweight and easy to use. It is intended to enable the surgeon to usethe instrument with one hand, thus freeing the other hand forperformance of other surgical tasks.

To the extent not already indicated, it also will be understood by thoseof ordinary skill in the art that any one of the various specificembodiments herein described and illustrated may be further modified toincorporate features shown in other of the specific embodiments.

Although the endoscopic surgical instrument of the subject invention hasbeen described with respect to a preferred embodiment, it is apparentthat changes may be made to the invention without departing from thespirit and scope of the invention as defined by the appended claims.

What is claimed is:
 1. A surgical apparatus comprising:a) a handle portion; b) a body extending from said handle portion, said body defining a longitudinal axis; c) a retractor assembly operatively associated with a distal portion of said body and including a plurality of interleaved retractor blades movable about a common pivot axis, said pivot axis extending perpendicular to said longitudinal axis of said body; d) actuation means associated with said handle portion and said body for moving said plurality of retractor blades between an open position and a closed position; and e) spacer means disposed between adjacent retractor blades of .said retractor assembly coaxial with said pivot axis for maintaining clearance therebetween.
 2. A surgical apparatus as recited in claim 1, further comprising clutch means in association with said actuation means for controlling blade operation.
 3. A surgical apparatus as recited in claim 2, wherein said clutch means comprises a ratchet mechanism configured for controlling axial rotation of said actuation means.
 4. A surgical apparatus as recited in claim 1, wherein said retractor assembly includes first, second, and third interleaved retractor blades, and said spacer means includes a first spacing member disposed between said first and second retractor blades, and a second spacing member disposed between said second and third retractor blades.
 5. A surgical apparatus comprising:a) a handle portion; b) a tubular body extending distally from said handle portion, said tubular body defining a longitudinal axis; c) a retractor assembly operatively associated with a distal portion of said tubular body and including a plurality of interleaved retractor blades movable about a common pivot axis, said pivot axis extending perpendicular to said longitudinal axis of said tubular body; d) an actuation assembly associated with said handle portion and said tubular body for moving said plurality of retractor blades between an open position and a closed position; e) spacer means disposed between adjacent retractor blades of said retractor assembly coaxial with said pivot axis for maintaining clearance therebetween; and f) clutch means associated with said actuation assembly for controlling blade operation.
 6. A surgical apparatus as recited in claim 5, wherein said clutch means comprises a ratchet mechanism configured for controlling axial rotation of said actuation means.
 7. A surgical apparatus as recited in claim 5, wherein said retractor assembly includes first, second, and third interleaved retractor blades, and said spacer means includes a first spacing member disposed between said first and second retractor blades, and a second spacing member disposed between said second and third retractor blades.
 8. A surgical apparatus comprising:a) a handle portion; b) a tubular body extending from said handle portion, said tubular body defining a longitudinal axis; c) a retractor assembly operatively associated with a distal portion of said tubular body and including a plurality of interleaved retractor blades; d) actuation means associated with said handle portion and said tubular body for moving said plurality of retractor blades between an open position and a closed position, said actuation means operating along said longitudinal axis; and e) clutch means in coaxial alignment with said actuation means and disposed within said handle portion for controlling blade operation.
 9. A surgical apparatus as recited in claim 8, further comprising spacer means disposed between adjacent retractor blades of said retractor assembly for maintaining clearance therebetween.
 10. A surgical apparatus as recited in claim 8, wherein said retractor assembly includes first, second, and third interleaved retractor blades, and said spacer means includes a first spacing member disposed between said first and second retractor blades, and a second spacing member disposed between said second and third retractor blades.
 11. A surgical apparatus comprising:a) a handle portion; b) a tubular body extending from said handle portion; c) a retractor assembly operatively associated with a distal portion of said tubular body and including a plurality of interleaved retractor blades arranged in a progressive stepwise configuration; and d) an axial drive screw assembly associated with said handle portion and said tubular body for moving said plurality of retractor blades between an open position and a closed position.
 12. A surgical apparatus as recited in claim 11, wherein each of said retractor blades has a rectangular cross-section.
 13. A surgical apparatus as recited in claim 11, wherein said retractor assembly includes first through fifth interleaved retractor blades.
 14. A surgical apparatus comprising:a) a handle portion; b) a body extending from said handle portion; c) a retractor assembly operatively associated with a distal portion of said body and including a plurality of interleaved retractor blades; d) actuation means associated with said handle portion and said body for moving said plurality of retractor blades between an open position and a closed position; e) spacer means disposed between adjacent retractor blades of said retractor assembly for maintaining clearance therebetween; and f) a ratchet mechanism configured to control axial rotation of said actuation means. 